WQ0033357_More Information (Received)_20230614

Initial Review
Reviewer
Nathaniel.Thornburg
Is this submittal an application? (Excluding additional information.) *
Yes No
If not an application what is the submittal type?* Annual Report
Residual Annual Report
Additional Information
Other
Permit Number (IR) * W00033357
Applicant/Permittee S & J Villari Livestock, LLC
Email Notifications
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name* Gerald Matthews
Email Address*
[e-mail]
Project Information
.........................
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
9102897500
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number:*
WQ0033357
Has Current Existing permit number
Applicant/Permittee Address*
892 Penny Branch Rd., Warsaw, NC 28398
Facility Name*
S & J Villari Livestock Class B Residuals Program
Please provide comments/notes on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
WQ0033357 2ND REQUEST.pdf 5.6MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be accepted for pre -review until the fee (if required) has
been received by the Non -Discharge Branch. Application fees must be submitted by check or money order and made payable to the
North Carolina Department of Environmental Quality (NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date 6/14/2023

Livestock., R
892 Penny Branch Rd.
Warsaw, NC 28399
[phone] PHONE
(910) 293-41 9 FAX
ot
06/14/2023
ATTN: Zachary J. Mega
NCDEQ Division of Water Resources, Non -Discharge Permitting Unit
Subject: S & J Villari Livestock Class B Residuals Program - WQ0033357
Zachary:
We have answered all the questions on your 2"d request and included an updated Vicinity Map
A. Application (RLAP 06-16):
1 item 111.4 a — The calculated valves have been Corrected.
2. Item 111.4 c — The calculated valves have been Corrected.
D. Application ( RSC 06-16):
1. Item 11.5c — The calculated Sodium Adsorption Ratio (SAR) has been Corrected.
2. Item 11.5.e —The calculated PAN has been corrected.
L. Setback Waiver Agreements
Party 1: Howard, Kimberly Beth - Book/Page: 2031 / 65 — 2 Pages
;Party 2: Carbon Cycle North Carolina LLC - Book / Page: 2031 / 67 — 2 Pages
r'#ease do not hesitate to contact our office should you have any questions, comments, or require
any additional information. Ge_r_al_d mavfgmail.com
Than
Gerald Matthews
S&J Villari Livestock, LLC
Cc: Sam Villari, Owner

State of North Carolina
DWF
Department of Environmental Quality
Division of Water Resources
Division of Water Resource* 15A NCAC 02T.1 100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMFN`1'ATION
1 Please use the following instructions as a checklist in order to ensure all required items are submitted. Adhercacl• tt, 1!wNL
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of addiiiwi. s
information requested. Failure to submit all of the required items will lead to additional processing and review time for tltc
permit application. Unless otherwise noted, the Applicant shall submit one oriUinaI and two copies of the applicatimt and
supporting documentation --
I"or more information, visit the Water Uzlality Permitting Section's Non -Discharge Permining Unit
s v; t;ct tti ! h;s :application is for treatment, storage, transport, and/or land application of Class B residuals (may include residual~ that
are: gener t€ed from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 01-T .I 100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (All Application Packages):
Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-10) Form. Please
do not make any unauthorized content changes to th is forth. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long; as the attachments are numbered to correspond to the section and item to which they
refer.
The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An nItern.rte
person may be designated as the signing; official if a delegation letter is provided from a person who meets the criteria in 1.4A
NCAC 02T .0106(b).
lfthis pro.jcct is for a modification of an existing permit, submit one copy of the existing permit.
Please submit this application form at least 180 days prior to the expiration date on the existing permit. or 90 day.., pri(V It,
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage unit,.
B. Application Fee (New and Major Modification Application Packages)
J s;il-�w4 clicck. money order or electronic funds transfer made payable to: North Carolina Departrirent Of 1-:rivi::,n:
Q,l, ilii} {NC DEQ).
Facility Classification New Permit Major Modification '
µ
v17jor (.land are permitted for > 300 acres) f $1,310 $395
Minch ( land are permitted for < 300 acres) l $810 S245
' - A major modification shall be defined as any permit modification that: increases the generating facility's residuals dry tonnage;
adds additional land application areas not previously approved for that particular program [includin- tratisferrin,; of tieldls) from
orte program to another], adds additional residuals sources; or includes the addition of new treatment or storage IInits/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC I C .0300)
�] Submit a cony of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (1:;1S).
kilo -nation on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the ic5�.
trcotnrcnt z�.,w storage facilities. An EA may also be required for private systems if any public funds and/or binds a c t=Y_d i0i
the ctmstr.,Ltdon of the subject facilities.
l("i IONS F OK FORM: RLAP 06-16 Page I of3

V. Operation anti Maintenance Plan (New and Renewal Application Packages)
❑ For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
❑ Suhrnil the O&M Plan in accordance with 15A NCAC 02`i' . I 110 and include at a minimum:
Operational functions; describe the operation of the program to show what operations are necessary for the progratt€ to
function and by whom the functions are to be conducted.
Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
❑ Safety measures; may include safety training program, manuals, signs, etc.
❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
Frequency and location of inspections, including those to be conducted by the ORC, and procedures tO assure 01X t1€e
selected location(s) and inspection frequency are representative of the residuals management program_
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
El Sampling and monitoring plan including the following information;
Names and titles of personnel responsible for conducting the sampling and monitoring.
Detailed description of monitoring procedures including parameters to be monitored.
❑ Samplin€, frequency and procedures to assure that representative samples are being collected. Fluctuation in ten1l)rra1Z11e.
flow, and ether operating conditions can affect the quality of the residuals gathered during a particular sampling event. Tfic
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is lnoo
likeiy to be negatively affected by cold temperatures.
1*11F: FOLLOWING ADDITIONAL ITEMS_(G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
Q Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1 1 (l2Z. Specifically, a residuals land application program is designated as dedicated if any of the following are applicable:
Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
.treater than agronomic rates.
Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
Any land application site certified for the residuals land application program that receives residuals th€-ough fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals prcwwrase
falls under the dedicated program definitions.
G. Program Information
Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H, Detailed Site Maps (All New or Modification Application Packages)
Submit three (3) sets of standard size plans and two (2) sets of t 1" by 17" plans (electronic format is acceptable - Adobe 111A
only). For Modifications, submit plans specific to the modification(s) only.
Mans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑. Setbacks as required by 15A NCAC 02T.] 108
ED Site property boundaries within 500 feet of all waste treatment, storage, and disposal sit.e(s).
El A map Showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaivation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOIZ RLVIEV ONLY. NOT FUR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However. the plans may be labeled With
the phrase. FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RLAP 06-16 Pauc• 2 of")

1. Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
El Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
J. Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
Q Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC 02T .1 104(d)(4} and current Division Policy
available at: http://www.ncwater.orWRules Policies and Regulations . The document shall be signed, sealed and d:ilod Im ,r
qualified professional.
K. Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irri,tcaicfr
facili:ics fed through fixed supply system)
El SUblllit cngineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and or-
Profession:al Land Surveyor in accordance with 15A NCAC 02T A l04(d)(?2). For Modifications, submit an updated site tilap
specific to the modification(s) only.
The design documents must include the following minimum items:
0 Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
Speciticaticx:s describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
[ t;ttgincering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
0 Soil mapping units shown on all disposal sites.
L. Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed ir-r•i4-ation Facilities or
irrigation facilities fed through fixed supply systems)
Q Submit a completed and accurate water balance in accordance with 15A NCAC 02T .1 104(c1)(5) and current Division Poiicy
available at: httl)://www.ncwater.ora/Rules Policies and Regulations/.
M. Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated u-callent
or irrigation components)
Q Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
El An casement running with the land specifically indicating the intended use of the property and meeting the requirctnrnW, of-
i.�A NCAC QL .0107(fl, or
Q A written notarized lease agreement signed by both parties, indicating the intended use of the property. as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NLIMBER: [phone]
INS"FRUC TIONS FOR FORM: REAP 06-16 Page 3 of 3

State of North Carolina
AV
Department of Environmental Quality
x� Division of Water Resources
€ ivision of Water Resources 15A NCAC 02T A 100— RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: S & J Villari Livestock LLC
Applicant type: Individual Z Corporation lGeneral Partnership Privately -Owned Public Utility
Federal 0 State El Municipal County
Signature authority's name per 15A NCAC 02T .0106: Sam Villari Title: Owner
Applicant's mailing address: 892 Penny Branch Rd.
City: Wallace. State: NC Zip: 28398-. '
Telephone number: [phone] Email Address: sam.v c vfgmail.com
Consultant's name: License Number (for P.E.):
Affiliation: ;Q On Staff Q Retained (Firm: )
Consultant's mailing address:
City: State:Zip:
Pi-
lel phone number: (.
Email Address
3. Agronomist's name:
License Number: .
Affiliation: [] NIA Q On Staff
Q Retained (Firm: .
Agronomist's mailing address:
City: State
Zip: a-'F
Telephone number: {,) �::�
Email Address ,
4. Soil Scientist's name: '..:,°:
License Number:
Affiliation: Q N/A ER. On Staff
E3 Retained (Firm: `
Soil Scientist's mailing address:
City: State:
Zip: k --
Telephone number: (_ _i _
Email Address:.,:
5. ["cc submitted: � (See Instruction B)
11. PERMIT INFORMATION:
1. Application is for (check all that apply):Q new, 01 modified, Mrenewed permit
2. Ff this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: _W_Q003 3357
Date of most -recently issued permit. November t 1 2017
Date of most -recently certified Attachment A (if different than the permit)::: a'r
Date of most -recently certified Attachment B (if different than the permit):
FORM: RLAP 06-16 Page I of 5

Ill. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
l . Residuals Processing Facility's physical address: 892 Penny Branch Rd.
City: Warsaw State: NC 'Lip: 28398- "
Coordinates: Latitude: 35" 0` 39" Longitude: 78" T 20"
Datum: Unknown Level of accuracy: Unknown
Method of measurement: Man interpretation by extraction
2. County where residuals land application program is headquartered: Duplin
I,i:,.t tl,,� Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application prod -rang, 111cir
certilcation numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Gerald L Matthews
The Pork Company
1007103
! Back -Up ORC
Joshua Tray Batchelor.
Agriment Services
993694
- Additional Back -Up
O RC s.
if applicable)
_
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitroiren Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in thy
following table:
Maximum amount of residuals to be certified: 11.6 dry tons per year.
PAN
Pounds of PAN per Dry Ton
Pounds of PAN per Year
(Weighted Average)
Surface
Incorporation
Surface
Incorporation
or Injection
or Injection
First -Year
32
376
Five -Year Maximum Adjusted
46
""
533
W
b. I and .4alicafon Site Use Summary: Summarize information regarding the land application sites as currently certified and
propo,;cd For certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
-_
Row Crops
Hay
5.52
------—
-- Pasture...
--
Total:
5.52
methods
Surface
5.52
Contract tanker spreader
Incorporation or Injection
Total:
5.52
FORM: RLAP 06-16 Page 2 of

c. Re.yiduals Land Application Summary: Determine the minimum acreage required to land apply the residuals as currentlN
certified and proposed for certification assuming the scenarios listed in the following table:
r Assumed
l Application hate
(1hs ! JNlac.yr)
l
Acres Required Using
First -Year PAN Concentrations
Acres Required Using
Five -Year Maximum Adjusted PAN
Concentrations
Surface
Incorporation or
Injection
Surface
Incorporation or
Injection
50
3.06*
44
5.94
..
100
1.53
":'=
2.97"
150
1.02
r_ :, ;
1.98
200
0.77
3 '
1.48
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation of North Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.): NIA
7. Specify type of residuals program (See Instruction F): 0 Non -dedicated Q Dedicated
f Dedicated, specify the following (check all that apply):
[] Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crap
production is of secondary importance, explain; ME
E, Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;2L
IV. RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and subm it the following Residuals Source Certification and all associated documentation.
VW
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documental ion.
F
Land Application Sflte
Certification. doc
FORM: RLAP 06-16 page 1 of

Note: item Vi. Applicable to Dedicated Program. with fixed irrigation system oniy.
VL DESIGIN ?NFG- RrVIATION FOR FIXED IRRIGATION SYSTEM
I _ The irrigatlo-n system is: 1 Spi a.r L:rl' Drip
2. Disposal system is:.�� , CX stin- Tj proposed,
3. Miniman depth to mean. seasonal high water table (SHWT) within irrigation sites(s) per Soil Scientist's Evaluation: 1.5 feet
below ground surface. Rules 154A NCAC 02..0505(tr� requires at least one -fool; vertical separation between SHWT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of ariv irrigation. area?
Yes or zj No If 'Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be ma m ned or modiiled:
5. Loading rates recommended by the Soil Scientist Evaluation -
Soil Series I Fields within Soil Area
Recommended
Loading Rate
�nl�yrl
Recommended
Loading Rate
-- 1
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
'des o! ?'1�o If No, explain wiry 15A NuAC 02T.0505 Dn.i is not met:
7. Non -dedicated System Design (till in the appropriate information for either a spray or drip irrigation system):
Field1 done
Design Area Number of
!1 =` I plc=les
Maximum Application
Ratc(gallons/hr)
Design Annu.,31 Loading
Rafe {gn kr,rss/
Total
Spray Irrigation Desigl: Element
Wetted diameter of A ozzlws
Wetted area of nozzles
Nozzle capacity
Nozzle manufacturer 1 model
Elevation of E..6est nozzle
-T FIl Sheet ; S1)eci!""+eatio R
;VL!► her Pa,-�e NninbeF-
gpm
I
..f
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105.
Z Yes ❑ No, Explain;.'.." ` ::-
S:gLVA To !Z G V 11, L. e\ It.1
(Signature Authority's Name - PLEASE PRINT)
,s { riG- Nl L,-M +3 LR.
(Title)
attest that this application for -i 3 V 1 LL,1\ti 1 L I VO--f TO C V- L L G __
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. Further, any discharge of residuals to surface waters or the land will result in an immediate enforcement action,
which may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes §143-215.6A and §143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: t: Date: 1� /1� /--) a
FORM: RLAP 06-16 Page 5 of 5

State of North Carolina
D, Department of Environmental Quality WI RDivision of Water resources
Oh.lslon of %Varec Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
fur ralure information, visit the Waler Quality Perrnilling Sections Non-.Dischar_ le ferrnilliirg_t/nit
General — This certification provides detailed information of residuals source generating facility and its residuals quality iirr land
application, distribution, or disposal in accordance with 15A NCAC 02T .I 100. Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-15).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documemation li"Ii :J
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC I 1-15) form. Plc;isc do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachntcnts, io ilia•
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
El For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that are affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
R. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map ,Cikiidq tier
Iesitl��:;15 [,,tern l A striicarion Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in item 1. S.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the lilc of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, dktril3uted,
and/or disposed, including any chemicals, amendments, or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source -generating facility. Ensure that the Ilan it#cntii-ics
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addi°:ion.
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogeny rednL:J(m mli:
vector attractions reduction requirements. Note that all sampling and monitoring must be completed on the residi:.i;11 .r"
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ Foreach Source facility, attach the following:
❑ Laboratory analytical reports and operational data- reports for all laboratory analyses used to complete this certification.
❑ Documentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals generated from a similar facility along with the description of similarities of the two
facilities.
INSTRUCTIONS FOR FORM: RSC 06-16 Page I of l

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Divlslon of dater ResGumes
State of North Caroling
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICATION
FORM: RSC 06-16
1. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: S & J Villari Livestock
2. Facility permit holder is: ; 'T€ Federal, M State, a Local Government, or H Private.
Facility permit issued by: 12 Div. of Water Resources, EJ Div. of Environmental health,
or Ej Other (explain ).
3. I acility contact person and tide: Gerald Matthews
Complete mailing address: 892 Penny Branch RD.
City: Warsaw State: NC Zip: 28398-- ="74
Telephone number: [phone] E-mail address: Gerald.m rr vf_umail.com
4. Facility physical address: 892 Penny Branch Rd.
City: Warsaw State: NC Zip: 28398-ay '_
Coordinates: Latitude: 35" 0' 22" Longitude: 78' 7' 20"
Datum: Unknown Level of accuracy: Unknown
Method of measurement: Map interpretation by extraction
5. Purpose of the facility:
El treatment of municipal wastewater, treatment of 100% domestic wastewater,
0 treatment of potable water, treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: �` % industrial and L....'�:a %domestic)
other (explain:
6. Does the facility have an approved pretreatment program: E3 Yes No
7. Facility permitted/design flow: 0.1000260 MGD and facility average daily flow: 0.070000 MGD
8. Average amount of residuals being generated at this facility 11.6 dry tons per year.
tt. Specify the following regarding treatment and storage volumes available at the facility:
Tvpe and volume of residuals treatment: Biological sludge and grit remaining after solid separationidered of[_sitd find
factilialive_d,igestion in a 3,650.4428- gallon synthetically lined lagoon and 1.88 million gallon above-gLgLind staiinlrss steel_
stnregp tank.
Type and volume of residuals storage (i.e., outside of residuals treatment units): None
11. RESIDUALS QUALITY INFORMATION (See Instruction C.);
1. Spec ity if residuals are regulated under:
C] 40 CFR Part 503 or IN 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 021'. 1102(6) as:
CR Biological M Non -Biological
FORM: RSC 06-16 Patie 1 ol'5

Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
3. Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA. (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: E3 yes no.
[1-yes. list the numbers}:.."6�;
"
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 C F R §261 21-
26124: 0 yes 9 no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure (TCLP) analysis as
well as those for corrosivity, ignitability, and reactivity:
Laboratory: l nvirochem and Date of analysis: 2023-16-01
Passed corrosivity test: N. yes El no. pH: 8.08 sm. (2 < pH < 12.5)
Passed ignitability test: CR. yes 13 no. Flashpoint: >212 T (> 140°F)
Passed reactivity test: Wyes Ono. HCN: <l mg/kg (<250) & HIS: 0.25 mg/kg (<500)
TCLP Parameter
Limit
(mg/l)
Result
(rng/l)
TCLP Parameter
Limit
(129/1)
Result
OHg/l)
Arsenic
5.0
<1.0
Hexachlorobenzene
0.13
•:.050
Barium
100.0
<1.0
Hexachloro-13-Butadiene
0.5
--0.t)50
Benzene
0.5
<0.01
Hexachloroethane
3.0 �
=0.050 �
Cadmium
1.0
<1.0
Lead
-5.0
1.0
Carbon Tetrachloride
Chlordane
0.5
0.03
<0.01
<0.02
Lindane
Mercury
0-4
0.2
_ :-0.0005
'0.000'
Chlorobenzene
100.0
<0.01
Methoxychlor
10.0
.0.0005
Chloroform
Chromium
m-Cresol
6.0
5.0
200.0
<0.0I
<1.0
<0.050
Methyl Ethyl Ketone
Nitrobenzene
Pentachlorophenol
200.0
2.0
100.0
i <0.05
<0.050
<0.250
o-Cresol
200.0
<0.050
Pyridine
5.0
<0.050
p-Cresol
200.0
<0.050
Selenium
1.0
<1.0
Cresol
2,4-D
1,4-Dichlorobenzene
200.0
10.0
7.5
<0.050
<0.003
<0.050
Silver
Tetrachloroethylene
Toxaphene
5.0
0.7 i
0.5
<1.0
'0.01
0.05
1,2-Dichloroethane
0.5
<0.001
Trichloroethylene
0.5
<0.01
1, 1 -Dichloroethylene
0.7
<0.001
2,4,5-Trichloropheno1
400.0
.,'0.050
2,4-Dinitrotoluene
0.13
<0.050
2,4,6-Tri ch loroph en ol
2.0
-:0.050
Endrin
0.02
<0.0005
2,4,5-TP (Silvex)
1.0
0.007 i
LFrleptachlor and its Hydroxide
-
0.008
<0.0005
Vinyl Chloride
0.2
_-
'0I
--- - .._-.... _
I.ORM: RSC 06-16 Page 2 oI,, '

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T . 1105.
a. Fnr Distribution/Lund Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: F.nvirochem and Date of analysis: 2023-06-01
Parameter
Ceiling
Monthly Average
Result
Concentration Limits
Concentration Limits
(Class'A & ClassB)
(Class A Only)
(mg/kg)
(mg/kg)
(n1g1k Z)
Arsenic
75
41
- —,
<64.4
Cadmium
85
39
< 12.9
Copper
44300
1,500
653
Lead
840
300
70.3
Mercury
57
17
<0.742
Molybdenum
75
n/a
18.1
Nickel
420
420
25.0
Selenium
100
100
<12.9
Zinc
7,500
2,800
1220
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratoryand Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Dine
(Ineters. "')reek one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
3
(mg/kg)
0 > 0 but < 25
- —
30
200
210 - -
225 but < 50
34
220
240
> 50 but < 75
39
260
270
75 but < 100
46
300
320
100 but << 125
53
360
390
> 125
62
450
420
Result (mglkg)
FORM: RSC 06-16 Pa<<c 3 of 5

5. Nutrient/Mieronutrient Determination: Complete the Following:
a. Total solids: 2.36 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Envirochem and Date of analysis: 2023-06-01
Parameter
Result
(nag/kg)
Aluminum
1 110
Ammonia -Nitrogen
Calcium
17600
14400
Magnesium
1280
Nitrate -Nitrite Nitrogen
27.9
i pli (Standard Unit)
8.08
Phosphorus
27.9
Potassium
3780
Sodium
9620
- Total Kjeldahl Nitrogen
54500
C. Using the results listed in Item 1I. 5b. above, calculate the sodium adsorption ration (SAR): 3.1_6
[Note: II'residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Servicc. a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shay:
address the sodium application rate, soil amendments (e.g., gypsum, etc.), or a mechanism for maintaining site inlqgrhr
and conditions conducive to crop growthl.
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 20 %, This -
rare
is a (check one): default value, or actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals: Same as current surface
irrigation perrrrit residuals are anaerobically digested.
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (]I") Year PAN
Five -Year
Maximum Adjusted PAN
(mg/kq)
(mg/W
Surface
16208
22978
l n j ec t ion/ 1 ncorporati on
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and prom idc
the results of the latest analyses: None
I-ORM: RSC 06-16 Page 4 cif

7. Pathoun Reduction: Per 15A NCAC 02T.1106, specify how residuals will meet the pathogen reduction requirements:
a. for Distribution/Land Application of Class A or Equivalent:
D A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
A salrl onella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
Alternative l [ I5A NCAC 02T.1 106(b)(3)(A)] - Time/Temperature Compliance.
Alternative 2 [15A NCAC 02T.1 ]06(b)(3)(B)] - Alkaline "Treatment.
El Alternative 3 [15A NCAC 02T.1 ]06(b)(3)(C)] - Prior Testing for Enteric Virus/Viable 1lehninth Ova.
Alternative 4 [15A NCAC 02T.I 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Heltninth Ova.
Alternative 5 [15A NCAC 02T.1 ]06(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: composting, ¢iPi heat drying, heat treatment,
thermophilic aerobic digestion, beta ray irradiation,
gamma ray irradiation, or pasteurization.
h. For land Applieation of Class B:
0 Alternative I [15A NCAC 02T.1106(c)(1)] - Fecal Coliform Density Demonstration.
Fj Alternative 2 [15A NCAC 02T.1106(c)(2)] -Process to Significantly Reduce Pathogens (PSRP).
Specify one. aerobic digestion, air drying, anaerobic digestion,
composting, or Ej lime stabilization.
c. 1,orSur fare Di.Wosal:
0 Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item I1. 7a. above.
Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item 11. 7b. above.
ram. Exempt - If Daily Cover Alternative is chosen in Item 11.8. below [] 5A NCAC 02T.1 106(a)(2)].
Ej Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T.1 107, specify how residuals will meet the VAR requirements:
Alternative 1 [ 15A NCAC 02T. 1107(a)(I )] - 38% Votatile Solids Reduction (Aerobic/Anaerobic Digestion).
Alternative 2 [15A NCAC 02T.I I07(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative 3 [ 15A NCAC 02T.I 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [ 15A NCAC 02T. l 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion}.
Alternative 5 [I5A NCAC 02T.1 107(a)(5)] - 14-Day Aerobic Processes.
Alternative 6 [15A NCAC. 02T.1 107(a)(6)] - Alkaline Stabilization.
[� Alternative 7 [15A NCAC 02T.1 107(a)(7)] - Drying of Stabilized Residuals.
Alternative 8 [15A NCAC 02T.I 107(a)(8)] - Drying of Unstabiiized Residuals.
A Iternative 9 [ 15A NCAC 02T.1 107(a)(9)] - Injection.
Alternative 10 [ 15A NCAC 02T.] 107(a)(10)] - Incorporation.
0 Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.1 107(b)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of5

III IIIIIIIIIIIIIIIIIIIIIIIIf I II III
Doc No 10049993
Recorded, 06/12/2023 04:04-46 PM
Fee Arnt: S26.00 Page 1 of 2
Duplin County North Carolina
Anita Marie Savage, Register of Deeds
8K 2031 PG 65 - 66 (2)
,STATE OF NORTH
COUNTY OF ou�RNtfI
This Instrument
Registration on the Date been Glee for
Book and Page shown en he First I the
rime
hereof, and is being returned for
YneI safekeeping.
Marie 5arage. Reg{st� e
11P
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02'I' .0506(a), .0506(b), .0606(a), AND .0706(a)
Kimberly Beth Howard (printed name), certify that 1 am a deeded owner or an
authorized agent of the property located at:
Address: 392 Bruce Costin Rd. Parcel No.: 01-1485
City: Warsaw State: NC._ __ Zip Codc: 28398 County: _ Du!p in
Furthcnnore, I certify that I am authorized to make decisions regarding this property, and that 1 do lici-0)y
agree that the setback distances cited below be granted to the Applicant/Permittee listed on the. 1<riic
1 understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified ahore,
I consent to the following reduced setbacks:
El Wastewater Irri ation/Infiltration Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
n ' k astewater Irrigation/Infiltration Setback to Places of Assembly
The required setback of 400 feet is reduced to 240 feet, thereby allowing wastewater effluent
irrigations or infiltration no closer than 240 feet from my residence(s) or place(s) of assembly.
U Wastewater 'Treatment and Storage Unit Setback to Propertj Lines
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my property, line.
Wastewater Treatment and Storage Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my residence or place of
assembly.
Signature: - Date: a�
FORM: NDWSW 12-20

Book 2031
Page 66
Applicant/Permittec: S & J_ Villari Livestock, LLC Permit No.: WQ0033357
Address: 892 Penny Branch Road Parcel No.: 01-32 / 01-1029
City: Warsaw State: NC Zip Code: 28398 County: ___ Dt�lin_ __
NORTH CAROLINA, COUNTY
1, Q -r- cn, a Notary Public for XiCyt_QSOQ County, North Carolina.
do hereby certify that ,4 9-)�_A4-N } [-rol personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Wiluess my hand and official seal, this the i day of
Np
cn i 0
E Z : Signature o f Notary Public
s•'.,Gg�1G,�A �G;r 4ty commission expires
�0U _ ,N
Once notarized, this forin shall be recorded at the Register of Deeds in the counly or counties in
which the described properties are located. A copy of the recorded waiver shall be sent to the
following address:
Division of Water Resources
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FOP, M: NDWSW 12-20 Page 2 o#'2

III IIIIIIIIIIIIIIIIIllllllilllllll
Doc No: 10049994
Recorded: 06/12/2023 04:04:47 PM
Fee Amt: $26 00 Page 1 of 2
Duplin County North Carolina
Anita Marie Savage, Register of Deeds
BK 2031 PG 67 - 68 (2)
ATE COUNTY OF DUPLQ1NA
N ,
This Instremeni has been tiled for
Registration on the oate. Time and in the
Book and Page shown on the First Page
hereot, and is being retumed for
your safekeeping. /-z
tdarie Saaage, Register o1 needs
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM 'WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BV
15A NCAC 02T .0506(a), .0506(b), .0606(a), AND .0706(a)
1, Carbon Cycle North Carolina LLC (printed name), certify that 1 am a deeded owner car :in
author'zcd agent of the property located at:
Addres: 813 Penny Branch Road Parccl No.: 01-1548
City: Warsaw State: NC Zip Codc: 28398 County: __Puplin
l'urthum,ore. I certify that 1 am authorized to make decisions regarding this property. and that i do hLr(2h
c. rk•c that the setback distances cited below be granted to the Applicant/Permittee listed on the Y6110-� ir.i
I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified above,
I consent to the following reduced setbacks:
Wastewater Irrigation/Infiltration. Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
(] Wastewater_ Irrigation/Infiltration Setback to Places of Assembly
The required setback of 400 feet is reduced to 160 feet, thereby allowing wastewater effluent
irngit ion or infiltration no closer than 160 feet from my residence(s) or place(s) of assembly.
❑ Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my property line.
❑ Wastewater Treatment and Storage Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction it'
wastewater treatment and storage units no closer than feet from my residence or place at'
assembly.
C� 1
Signature: `",y Date: ff(e OiZDZ3
--
i'1-1i:lZl: V)WSIV 12-20 Pagc 1 nl ,

Book 2031
Page 68
Applicant/Perrnittee: S & J Villari Livestock LLC__ Permit No.: WQ0033357
Address: 892 Penny Branch Road - Parcel No.: 01-32 / 01-1029
City: -. Warsaw _----__._ State.: NC Zip Code: 28398 County: _ Dugs _
NORTH CAROLINA, COUNTY
e
1, FLU �u. ���►`El PScI , a Notary Public for S1t.t CT—) County, North Carolina,
do hereby certify that ML hv! lC(ncc' personally appeared before me this day
and acknowledged the due execution of the foregoing instrument,
Vitnesw„ Md and official seal, this the Lk
M' rhl �•'''y
�,nnhgpry O
2 'Q�-:0
. L = o
• Q
CUN r
day of
Signature of Notary Public
My commission expires � - ) Le ' 9 U o'i C-
Office notarized, this form shall be recorded at the Register of Deeds in the county or counties in
which the described properties are located. A copy of the recorded Waiver shall be sent to the
following address:
Division of Water Resources
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 12-20 Page 2 of 2